Effects of Topical Hydrogen Purification on Skin Parameters and Acne Vulgaris in Adult Women
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Article
Effects of Topical Hydrogen Purification on Skin Parameters
and Acne Vulgaris in Adult Women
Karolina Chilicka 1,*, Aleksandra M. Rogowska 2 and Renata Szyguła 1
1 Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-060 Opole, Poland;
renata.szygula@uni.opole.pl
2 Department of Social Sciences, Institute of Psychology, University of Opole, 45-052 Opole, Poland;
arogowska@uni.opole.pl
* Correspondence: karolina.chilicka@poczta.onet.pl
Abstract: Background: Acne vulgaris is a prevalent dermatological disease characterized by skin
eruptions, which may decrease the sufferer’s quality of life. Hydrogen purification treatment is a
new procedure used in cosmetology to improve the skin parameters of the face. This study exam-
ined the effectiveness of hydrogen purification treatment to improve women’s skin conditions with
regard to acne vulgaris. Methods: In this study, 30 women participated who suffered from a high
level of sebum and acne. The control group was comprised of 30 healthy women with a low level of
sebum. The Hellgren–Vincent Scale and Derma Unit SSC 3 device were used to assess acne vulgaris
severity and skin properties, respectively. Four hydrogen purification sessions were carried out at
7-day intervals, using the Hebe Hydrogenium+ generating alkaline water. Results: At baseline and
7 and 14 days after finishing the series of treatments, the levels of oiliness, moisture, and skin pH
were tested. The main effects of treatment were significant in the following parameters: pH around
the bottom lip, moisture between the eyebrows and around the nose, and oily skin in all three face
sites. Conclusions: The level of sebum decreased and moisture levels increased during hydrogen
Citation: Chilicka, K.; Rogowska, purification. Topical hydrogen purification is an effective and safe treatment for acne vulgaris.
A.M.; Szyguła, R. Effects of Topical
Hydrogen Purification on Skin Keywords: hydrogen purification; acne vulgaris; alkaline water
Parameters and Acne Vulgaris in
Adult Women. Healthcare 2021, 9,
144. https://doi.org/10.3390/
healthcare9020144
1. Introduction
Received: 14 December 2020 The global prevalence of acne is 9.38% but varies widely due to the severity grading
Accepted: 29 January 2021 system, country, gender, and age, with rates being highest among adolescents in puberty
Published: 1 February 2021 (ranging from 35% to nearly 100%) [1]. Acne can persist in adulthood and can affect up
to40% of all women [2]. A recent study showed that acne’s family history is a risk factor,
Publisher’s Note: MDPI stays but the severity of acne vulgaris (AV) is independent of premenstrual flares, diet, and
neutral with regard to jurisdictional body mass index (BMI) [3]. Problems with skin eruptions can negatively affect quality of
claims in published maps and life and lead to heightened stress, depression, or even suicidal ideations [4,5]. The effects
institutional affiliations. of severe forms of acne are seen in deep acne scars, which can also decrease self-esteem
and quality of life [4–9]. Thus, an interdisciplinary approach to treatment should be pri-
oritized.
Among factors determining acne, the abnormal keratinization of the pilosebaceous
Copyright: © 2021 by the authors.
canal, bacterial colonization (i.e., Cutibacterium acne, Staphylococcus ureus, andStaphylo-
Licensee MDPI, Basel, Switzerland.
coccus epidermidis), increased production of sebum, skin inflammatory, genotypic factors,
This article is an open access article
and hormonal disorders can be distinguished. Treatment is often long and tedious, af-
distributed under the terms and
conditions of the Creative Commons
fecting the patients’ sense of hopelessness and social isolation. In recent years, consid-
Attribution (CC BY) license
erable attention has been paid to drug use as the best treatment for acne. Psychological
(http://creativecommons.org/licenses support is currently also recommended to improve acne [10–14]. However, new cos-
/by/4.0/). metology acne treatments, such as acid peels, microdermabrasion, cavitation peeling,
sonophoresis, and hydrogen purification treatment, are continually being sought.
Healthcare 2021, 9, 144. https://doi.org/10.3390/healthcare9020144 www.mdpi.com/journal/healthcare
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Healthcare 2021, 9, 144 2 of 15
Hydrogen has been known in the world of science for decades. It is the simplest
molecule in nature, created by two hydrogen atoms. Ohsawa et al. [15] showed that mo-
lecular hydrogen could selectively reduce reactive oxygen forms in vitro and exert anti-
oxidant activity. Thanks to this discovery, hydrogen gas has been used in 300 diseases
and have come to the forefront of therapeutic medical gas research. Clinical research has
shown that hydrogen is an essential physiological regulator factor with an-
ti-inflammatory and antioxidant effects on cells and organs [15–19].
Hydrogen purification treatment uses alkaline water (electrochemically reduced
water, ERP), which is rare in nature. However, with the chemical process of electrolysis,
ERP can be produced immediately with a pH range between 8–10. It has both high alka-
line and negative oxidation-reduction potential (ORP). The electrolysis process consists
of passing a direct current between two electrodes (anode and cathode) separated by a
semi-permeable membrane. During this process, the elements contained in the water
break down into hydrogen ions H+, focusing on the cathode, and hydroxy ions OH-,
which focus on the anode. Ionized alkaline water consists of H+ ions; it also contains al-
kaline elements, such as calcium, magnesium, potassium, hydrogen, and alkaline hy-
droxyl ions. Negative OH-ions form acid water, containing chlorine, sulfur, phosphorus,
positive acid ions, and oxygen.
The main factor responsible for the ORP of alkaline water is the active molecular
hydrogen in alkaline water. Its concentration, depending on the concentration of alkaline
water, ranges from 0.3 to 0.6 mg/L. Only the electrolysis processes (water ionizers) and
hydrogenation (hydrogen generators) allow water production with active hydrogen ions,
which is a natural and potent antioxidant. Currently, hydrogen cleansing is commonly
used in cosmeceutical treatments to reduce free radicals and achieve anti-aging proper-
ties. Reactive oxygen species bind to hydrogen ions, forming water and pure oxygen.
Through chemical processes, hydrogen purification neutralizes free radicals, and hy-
drogen water significantly reduces lubrication on the skin’s surface.
In recent years, research has been conducted into the internal effects of alkaline wa-
ter on patients affected by such problems as pyrosis, dysphoria, abdominal distension,
and chronic diarrhea [20–24]. The research confirmed that the drinking of alkaline water
for two weeks resulted in a significant health status improvement. However, little is
known about alkaline water’s superficial effect on selected skin parameters in people
suffering from acne vulgaris. To the best of our knowledge, the present study explores,
for the first time, the effectiveness of alkaline water in the treatment of acne vulgaris.
2. Materials and Methods
2.1. Participants in the Study
This prospective case-control clinical study with follow-up analysis was conducted
between January 2020 and February 2020 at Opole Medical School in Poland. It was ap-
proved by the Human Research Ethics Committee of the Opole Medical School
(KB/54/NOZ/2019), according to the principles of the Declaration of Helsinki. The study
was registered at the International Standard Randomized Controlled Trial Number
(ISRCTN) registry database (No. ISRCTN 13842359). All participants signed written
consent before the beginning of the study regarding participation in the study and the
use of photographic images for publication. A photo was taken before treatment and 14
days after finishing all four treatment sessions (front view, left oblique, and right
oblique). The subjects were informed that they could withdraw from the study at any
time without giving a reason. Initially, 123 people participated in the study, but 35 indi-
viduals met the exclusion criteria, and another eight persons did not meet the inclusion
criteria. After excluding 43 people from the study, the final study sample consisted of 80
women aged between 20 and 23 (M= 21.23; SD= 0.56).
Group 1 included 40 young adult women with a higher sebum level and acne vul-
garis (AV group). Participants were diagnosed with mild facial acne vulgaris using the
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Hellgren–Vincent Scale (HVS) to determine acne lesions’ severity. The HVS can accu-
rately determine the number of skin lesions in the form of lumps, pustules, and black-
heads. The AV group’s inclusion criteria were a young age, ranging between 18–25 years
old, and severe acne, with a second degree in the HVS (n= 23, 76.67%) and a third-degree
in the HVS (n= 7, 23.33%). The exclusion criteria for the AV group were severe acne, an-
tibiotics, and retinoids use for acne treatment within the previous four weeks, medication
use that could aggravate or suppress acne (vitamin B, halogens, antiepileptics, antide-
pressants, ciclosporin), oral contraceptive pill, oral antibiotics use within the previous
three months, pregnancy, breastfeeding, active inflammation of the skin, bacterial, viral,
allergic and fungal relapsing skin diseases, disturbed skin condition, recent surgical
procedures in the treating areas, active reduced immunity, epilepsy, claustrophobia, ac-
tive rosacea, eczema, psoriasis, numerous telangiectasias, numerous melanocytic nevi,
tanned skin, skin cancers, and recently having surgery (up to 2 months). Table 1 demon-
strates the prevalence of acne severity in AV group.
Table 1. Characteristics of acne vulgaris severity in terms of the Hellgren–Vincent Scale (HVS)
among participants of the acne vulgaris (AV) group (n = 30).
Baseline Days 14 After Finishing Treatment
HVS n % n %
I 0 0.00 16 53.33
II 23 76.67 14 46.67
III 7 23.33 0 0.00
Group 2—the control sample (CS)—consisted of 40 healthy young adult women
without any previously diagnosed dermatological problems or dermatological disease.
Individual interviews assessed these issues. The inclusion criteria for the CS were a
young age, ranging between 18–25 years old, good overall health condition, and lack of
dermatological problems. The exclusion criteria for the CS group included pregnancy,
breastfeeding, active inflammation of the skin, bacterial, viral, allergic, and fungal re-
lapsing skin diseases, disturbed skin condition, new surgical procedures in the treating
areas, active reduced immunity, epilepsy, claustrophobia, active rosacea, eczema, psori-
asis, numerous telangiectasias, numerous melanocytic nevi, tanned skin, skin cancers,
and recently having surgery (up to 2 months).
No other treatments were allowed during the study for both groups. During the
treatment series, 10people dropped out of both the AV and CS groups. Some of the peo-
ple did not appear at subsequent treatments. Some participants from the CS reported
excessive dryness of the skin after performing hydrogen cleansing. Finally, 30 women
from the AV group and 30 individuals from CS completed the study. The consort flow
chart of the clinical study is presented in Figure 1.
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Figure 1. Consort flow chart of clinical study group 1 (acne vulgaris, AV) and group 2 (control
sample, CS).
2.2. Apparatus for Hydrogen Purification Treatment
Hebe Hydrogenium+ was used for a series of hydrogen purification treatments
(Figure 2). The Hydrogenium+ is an innovative device for non-invasive and comprehen-
sive skincare. Patients from both AV and CS groups underwent four sessions of hydro-
gen purification treatment using the Hydrogenium+ device. The device has two cups:
Chalice 1 is used for the production of alkaline water and contains a generator with in-
take pipes, which allows the relentless determination of the part the alkaline water is in
(with the addition of calcium, magnesium, and potassium ions); Chalice 2 is intended for
used water.
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Figure 2. Hebe Hydrogenium+.
Chalice 1 is equipped with a water-insoluble membrane that stabilizes the system
(nanosilver) and two electrodes made of titanium, covered with a 25-micron layer of
platinum (thanks to which the electrolysis process takes place). When low-mineral water
(below 500 mg/L) is poured into Chalice 1, the device is switched on with the start button.
It is ready when it shows 100% preparation on the panel. In Chalice 1, on one side of a
membrane, alkaline water is located, which is used for the treatment, while on the second
side of the membrane, acidic water is placed (with chlorine and sulfur ions). The device
draws water in an alkaline environment. The parameters of the electric current used
during the treatment are 1 ampere and 150 volts. The water temperature is 25 °C when
heated by the device.
2.3. Treatment Procedure
A cosmetic makeup removal (micellar fluid) was performed at the first step of the
procedure. Next, hydrogen cleansing was conducted using the H2 peel head, sucked the
skin fold under a vacuum (supplying clean water with one cable), and flushed it with
hydrogenated water. Used water was sucked in the second wire connected to the head,
which drained it to the wastewater tank. The device’s power was set for each of the four
treatments at about a 10% vacuum; a higher dose could cause the appearance of ecchy-
mosis on the skin. This stage of the procedure was performed for 10 min.
The next stage of the procedure was applying an H2 jet head, using the potential of
active hydrogen (hydrogenated water injection), which had a nozzle “ejecting” the hy-
drogenated water under pressure. Power of 2 bars (intended for the face area) was used
here for each series of treatments. This head was guided at a distance of 2–3 cm from the
client’s skin for 5 min. Participants were treated at a 1-week interval for four sessions.
After the sessions, only moisturizing cream was applied to the facial skin of the
subjects. Home care was recommended, which consisted of washing the face with mi-
cellar fluid and applying only a moisturizing cream. During the study, the participants
were instructed that it was forbidden to perform any other cosmeceutical, exfoliating, or
apparatus procedures.
2.4. Skin Parameter Assessment
The Hellgren–Vincent Scale (HVS) was used for the clinical evaluations of acne
vulgaris severity. The HVS is a five-point scale in which a higher degree means a higher
level of acne, as follows: (1) erythema, blackheads, 1–5 papules or pustules; (2) erythema,
blackheads, 6–10 papules or pustules; (3) erythema, blackheads, 11–20 papules or pus-
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tules; (4) erythema, blackheads, 21–30 papules or pustules; (5) erythema, blackheads,
more than 30 papules or pustules [25]. The HVS was assessed before the treatment and
after 14 days from finishing four sessions of hydrogen purification. An example of a par-
ticipant from AV and SC samples is shown in Figure 3.
.
Figure 3. Example of participant’s forehead: (A) from AV group before hydrogen purification (HP);
(B) from CS group before HP; (C) from AV group 14 days after HP; (D) from CS group after HP.
The skin parameters’ functional measurements were performed twice (before
treatment, and 7 and 14 days after the complete session of four treatments), using a
Derma Unit SSC 3 device (Courage + Khazaka Electronic GmbH, Cologne, Germany).
The following skin parameters were measured: sebum (using Sebumeter, Courage +
Khazaka Electronic GmbH, Cologne, Germany), skin surface pH (using a Skin-pH-Meter,
Courage + Khazaka Electronic GmbH, Cologne, Germany), and skin moisture (using the
Corneometer, Courage + Khazaka Electronic GmbH, Cologne, Germany). Three meas-
urements were taken in the face of each participant: (1) between the eyebrows; (2) about 1
cm from the lobe of the nose (left and right); and (3) about 1 cm from the lower lip (on the
chin)—see the Supplementary Materials. Photos were also used to assess acne lesions
with the hydrogen purification treatment. The clinical photographs were taken at base-
line and 14 days after finishing four sessions of hydrogen purification.
2.5. Statistical Analysis
Firstly, acne vulgaris severity changes were assessed by comparing the HVS at
baseline and 14 days after finishing four sessions of hydrogen purification in the AV
group. The non-parametric Wilcoxon matched-pairs test was used for this purpose.
Secondly, descriptive statistics were calculated separately in AV and control groups for
each skin parameter, including the number of observations, mean, standard deviation,
minimum, and maximum. The normality of the distribution of the data sets was exam-
ined using the Kolmogorov–Smirnov d test.
Because all data showed normal distribution in both groups (p >0.05), the ANOVA
with repeated measures (at baseline and on weeks 1 and 2 after finishing treatment of
hydrogen purification) was performed to compare skin parameters (such as pH, sebum,
and moisture) in selected places of the face (between the eyebrows, around the nose and
around the bottom lip) in both groups (AV and control). Fisher’s least significant differ-
ence (LSD) post-hoc test was conducted to find significant differences between groups, as
well as between treatment conditions: test (at baseline) and retest (7 and 14 days after
finishing treatment). Also, the effect size for ANOVA tests was calculated using a partial
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eta-square coefficient. All statistics were calculated using Statistica 13.1. Software (Round
Rock, TX, U.S.).
3. Results
The number and percentage of women with a particular degree of acne vulgaris on
the Hellgren–Vincent Scale are presented in Table 1. At baseline, most participants in the
AV group were diagnosed with a second degree (76.67% of the sample) and several
people with a third-degree (23.33%) of AV. Two weeks after finishing hydrogen purifi-
cation treatment, around half of the participants were diagnosed with the first (53.33%)
and second (46%) AV degree. This shows that the level of AV decreases under the in-
fluence of hydrogen purification treatment in most individuals, which was confirmed by
the Wilcoxon matched-pairs test, n = 21, T = 0.00, Z = 4.02, p < 0.0001. Changes in the HVS
due to hydrogen purification treatment are shown in Figure 3 and Figure 4.
Comparison of skin parameters between AV and control groups is shown in Table 2.
Statistically significant group differences were found for sebum and moisture at all three
measuring sites of the face (between the eyebrows, around the nose, and the bottom lip).
The AV groups demonstrated higher scores for oiliness and lower scores for moisture
than the control group.
.
Figure 4. Differences in the HVS between two measurements: at baseline and 14 days after finish-
ing the 4-week treatment of hydrogen purification.
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Table 2. Means, standard deviations, and two-way ANOVA with repeated measure statistics for
study variables.
AV (n = 30) CS (n = 30) ANOVA
Variable M SD M SD Effect F ratio df η p2
PH between the eyebrows
Baseline 5.19 0.45 5.19 0.52 G 0.05 1, 58 0.00
Week 1 after treatment 5.27 0.40 5.24 0.42 T 1.45 2, 116 0.02
Week 2after treatment 5.28 0.26 5.26 0.18 G × T 0.04 2, 116 0.00
PH around the nose
Baseline 5.26 0.47 5.26 0.47 G 0.61 1, 58 0.01
Week 1 after treatment 5.23 0.29 5.35 0.35 T 0.68 2, 116 0.01
Week 2 after treatment 5.28 0.25 5.34 0.28 G × T 0.98 2, 116 0.02
PH around the bottom lip
Baseline 5.25 0.40 5.27 0.47 G 0.52 1, 58 0.00
Week 1 after treatment 5.20 0.29 5.10 0.31 T 4.19 * 2, 116 0.07
Week 2 after treatment 5.27 0.22 5.19 0.27 G × T 1.18 2, 116 0.02
Oiliness between the eyebrows
Baseline 205.87 33.23 92.73 29.85 G 147.99 *** 1, 58 0.72
Week 1 after treatment 146.60 30.05 91.07 30.45 T 50.93 *** 2, 116 0.47
Week 2 after treatment 141.90 31.02 86.53 17.79 G × T 38.86*** 2, 116 0.40
Oiliness around the nose
Baseline 193.77 42.12 80.97 37.90 G 68.29 *** 1, 58 0.54
Week 1 after treatment 139.67 45.87 81.30 41.65 T 28.57 *** 2, 116 0.33
Week 2 after treatment 136.63 43.27 82.77 24.06 G × T 30.97 *** 2, 116 0.35
Oiliness around the bottom lip
Baseline 179.87 43.22 76.63 28.73 G 83.17 *** 1, 58 0.59
Week 1 after treatment 140.40 42.18 86.40 37.28 T 11.07 *** 2, 116 0.16
Week 2 after treatment 135.87 38.38 80.63 20.67 G × T 20.25 *** 2, 116 0.26
Moisture between the eyebrows
Baseline 56.37 17.30 62.37 15.07 G 4.20 * 1, 58 0.07
Week 1 after treatment 58.21 16.90 65.59 16.31 T 4.78 ** 2, 116 0.08
Week 2 after treatment 59.71 19.08 70.06 16.78 G x T 0.78 2, 116 0.01
Moisture around the nose
Baseline 35.40 17.76 46.75 23.34 G 10.92 ** 1, 58 0.16
Week 1 after treatment 46.49 20.85 61.92 17.87 T 24.74 *** 2, 116 0.30
Week 2 after treatment 49.28 19.91 64.89 18.45 G × T 0.50 2, 116 0.00
Moisture around the bottom lip
Baseline 63.33 13.71 71.00 18.83 G 5.15 * 1, 58 0.08
Week 1 after treatment 61.77 16.15 71.19 18.88 T 1.79 2, 116 0.03
Week2 after treatment 63.36 16.33 75.02 21.09 G × T 0.91 2, 116 0.02
Note: N = 60. ANOVA = analysis of variance; AV = group with acne vulgaris (n = 30); CS = control
group without acne vulgaris; G = group; T = treatment of hydrogen purification. Oily skin param-
eter is expressed in units μg/cm2; moisture in g/m2/h.* p < 0.05, ** p < 0.01; *** p < 0.001.
The treatment was significant in the following parameters: pH around the bottom
lip, moisture between the eyebrows and around the nose, and oily skin in all three face
sites. According to expectations, the sebum level decreased and moisture levels increased
under the influence of hydrogen purification treatment. Fisher’s LSD post-hoc test
showed significant differences between the baseline test and retest after the first session
(p < 0.0001). The differences between the first measurement at baseline and two weeks
after the end of all four treatment sessions persisted (p < 0.0001). However, the second
and third measurements (7 and 14 days after the last sessions) did not differ significantly
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from each other (p > 0.05). An interaction effect between groups and treatments was also
found for oily skin in all three sites on the face. The Fisher’s LSD post-hoc test indicated
that treatment was effective in the AV group (p < 0.0001), but the oily skin among CS
participants did not change under the hydrogen purification treatment (p > 0.05). More
details are presented in Figure 5, Figure 6 and Figure 7.
4. Discussion
This 4-week study demonstrated that the hydrogen purification treatment designed
specifically for women with mild to moderate acne led to a significant improvement in
the severity of acne and the overall appearance and condition of the skin. To the best of
our knowledge, a hydrogen purification treatment was examined regarding the topical
cosmeceutical treatment of acne vulgaris for the first time in this study. The current
treatment is based on active hydrogen. As one of the most powerful antioxidants, active
hydrogen counteracts the aging process and alleviates inflammation and oxidative stress.
The high-quality Hydrogenium+ generator removes oxygen and unfavorable ions of
chlorine, sulfur, and phosphorus from the water, saturating it with active hydrogen and
beneficial calcium, magnesium and potassium ions. Hydrogen can easily penetrate deep
into the skin structures, bound with the most harmful free oxygen radicals, which effec-
tively neutralizes them and deprives the skin of harmful properties.
.
Figure 5. Comparison of mean values of skin acidity at baseline, one week, and two weeks after
finishing the treatment with hydrogen purification in both AV and CS groups. Error bars are
standard deviations.
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.
Figure 6. Comparison of mean values of oily skin at baseline, one week, and two weeks after fin-
ishing the treatment with hydrogen purification in both AV and CS groups. Error bars are standard
deviations.
Figure 7. Comparison of mean values of moisture skin at baseline, one week, and two weeks after
finishing the treatment with hydrogen purification in both AV and CS groups. Error bars are
standard deviations.
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Then, as water, it is excreted from the body. Hydrogen purification can improve the
skin’s efficient functioning, slowing down the aging process, and reducing the effects of
stress and environmental pollution.
This study demonstrated that hydrogen’s antioxidant activity mightalso affect
common skin pathogens (e.g., Cutibacterium acne, Staphylococcus ureus, Staphylococcus epi-
dermidis). It seems possible that the hydrogen may alleviate acne due to its antimicrobial
properties and by reducing the sebum level. Sebum plays a key role in the pathogenesis
of acne [26–28]. In turn, the reduced sebum levels can improve skin properties and re-
duce acne.The inflammation’s progress in the pathogenesis of acne may be related to
sebum changes and reactive oxygen species (ROS) releasing from the impacted damaged
follicular walls. Some of the common drugs in acne treatments, such as hydrogen per-
oxide, function by reducing ROS [29]. A previous study showed that adding hydrogen
peroxide to the preoperative skin preparation may be a low-risk method to reduce deep
tissue contamination with C. acnes [30–32]. Moreover, acne patients are recommended
alkaline soaps (pH 9–10) with various surfactants [33,34]. Hydrogen sulfide concentra-
tions in thermal spring waters showed inhibition properties on human origin’s bacterial
proliferation [35].
This study indicated that hydrogen purification treatment might positively reduce
skin eruptions and increase moisture, as well as decrease the skin’s oiliness in people
suffering from acne vulgaris. In particular, the sebum level was significantly decreased
only in the AV group, while skin moisture between the eyebrows and around the nose
was significantly increased in both the AV and CS groups. The appropriate level of skin
hydration plays a protective role in the skin barrier. Alkaline water may moisturize the
skin and improve the skin’s protective barrier. However, optimal times and methods of
daily cleansing and moisturizing facial skin may have an equally beneficial effect on
healthy skin [36]. Many cleansers also moisturize, prevent, and soothe skin irritation by
slowing down the evaporation of water.
The positive effect of the hydrogen purification treatment on the reduction of sebum
is probably due to alkaline water’s beneficial effects. Alkaline water has a high level of
pH, which can reduce excess sebum from the epidermis. Alkaline water seems to play a
vital role as a regulatory factor with anti-inflammatory and antioxidant effects on cells
and organs [15]. Some skin cleansers, such as soap (pH 9–10), have a similar pH to alka-
line water. However, washing a face with such a daily preparation would irritate the
skin. The hydrogen purification treatment was performed on our patients once a week,
thanks to which it brought excellent results in terms of reducing sebum without any side
effects [37].
The hydrogen purification treatment did not significantly change the pH of the par-
ticipant’s facial skin in both AV and CS samples. This result is consistent with previous
studies, which indicated that none of the five facial areas (i.e., forehead, nose, chin, and
right/left cheeks) differed significantly in pH between healthy participants and acne in-
dividuals [38]. The pH of the skin surface has an impact on the barrier function [34]. The
current results showed that the acidification of the examined people’s skin was in the
range of 4.1–5.8 pH, which is the norm for the general population [39]. Schürer [40] found
that a low pH level has skin protective properties, slowing down bacteria’s growth. On
the other hand, a large increase in pH may damage the skin surface, causing irritation,
which may adversely affect the skin microbiome. Various external and internal factors
can affect skin pH[34]. Skin moisture, sweat, sebum, anatomy, genetic predisposition,
age, and diet are among the many endogenous factors influencing skin pH. Exogenous
factors include detergents, application of cosmetic products, occlusive dressings, topical
antibiotics, humidity, season, and individual differences in behavioral habits. The current
study found that hydrogen purification did not affect facial skin pH in young women.
Perhaps this treatment was too short to change the pH significantly. Further research is
necessary to explain this question.
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Previous studies only examined the healing properties of alkaline water for internal
use by drinking it. For instance, Gadek et al. [41] found that the daily drinking of 2 L of
alkaline water (Nordenau and Hita Tenryosui water) decreased glucose HbA1c levels in
people with type 2 diabetes. Significant changes were observed after just six days, and
prolonged use of alkaline water caused a decrease in blood cholesterol and creatinine, as
well as an increase in density lipoprotein levels [41,42]. Furthermore, Osada et al. [43]
showed that drinking 2 L alkaline water (Hita Tenryosui water) per day for two months
significantly decreased blood sugar levels in 89% of diabetes patients. Similarly, blood
triglyceride and total cholesterol levels significantly decreased in 92% of patients with
hyperlipidemia. The study conducted by Higashikawa et al. [44] showed that drinking
alkaline water has an anti-metabolic effect, demonstrated by decreased starved blood
sugar levels, blood pressure, and total cholesterol LDL cholesterol, GOT, g-GTP, triglyc-
eride levels, arteriosclerosis index, and uric acid levels.
In contrast, an increase was noted in leptin levels, as well as the improvement of
constipation. Alkaline water has also been used to support cancer treatment [45–48]. Al-
kaline water suppresses tumor angiogenesis, inhibits scavenging intracellular ROS,
suppresses gene expression and vascular endothelial growth factor secretion, inhibits
cancer cells and microorganisms’ growth, and induces apoptosis along with glutathione
in HL60 human leukemia cells. The ease of formation of alkaline water and its univer-
sality can bring about many health-related effects in the treatment of many disorders,
including dermatological diseases and the maintenance of health. Thus, the promising
results of this study should be continued and confirmed in the future.
Previous research has shown the effectiveness of cosmeceutical treatment for im-
proving skin parameters and reducing the scars of people with acne vulgaris, using acid
peels, radiofrequency, and fractional microneedle radiofrequency, microdermabrasion,
sonophoresis, and intense pulsed light (IPL) [25,49,50]. Compared to other topical cos-
meceutical treatments, such as cosmetic acids [9,50], the hydrogen purification treatment
is not associated with the risk of irritation, reddening of the skin, or side effects as burn-
ing and itching of the epidermis surface. People with sensitive skin, prone to irritation
and with certain undesirable symptoms related to the type of skin (e.g., dryness, tight-
ness, coarseness, washout of makeup, quick production of sebum, feeling differences in
oiliness, frequencies of acne lesions, and oiliness) [51], should pay special attention to
treatments with the use of cosmetic acids or other topical therapies [52]. However, hy-
drogen purification appears safe and effective in improving this type of skin [53].
It should be added that hydrogen purification is not a treatment and cannot displace
dermatological methods [52,54]. However, it can support the other dermatological drug
and topical therapies [27]in moisturizing and reduce the level of sebum and skin lesions
among people with mild and moderate acne. For people with fistulas or cysts, the pro-
cedure is prohibited, and solely dermatological treatment is possible. It should be em-
phasized that the growing resistance to antibiotics in Cutibacterium acnes and other bac-
teria is becoming extremely alarming. Hydrogen purification can be used as an auxiliary
in people who have developed drug resistance due to excessive long-time use of prepa-
rations medicinally, and also in those individuals who cannot use topical agents in the
form of creams or ointments due to numerous side effects, such as severe irritation or
peeling of the skin [55,56].
Study Limitation
The present study used the HVS to assess the severity of acne vulgaris and the
Derma Unit SSC 3 device to measure selected skin parameters, such as the skin’s pH,
oiling, and moisture. In the future, we would like to use more measuring tools; for ex-
ample, a specialist camera could improve the test quality of the study. The Visiopor® PP
34 (Courage + Khazaka Electronic GmbH, Cologne, Germany) camera uses a specific
UV-light to visualize the fluorescing acne lesions of an area of at minimum 8 × 6.4 mm.
The orange-red fluorescence indicates Propionibacterium acne bacteria’s presence within
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clinically non-evident (follicular impactions and micro comedones) and clinically evident
(comedones, papules, and pustules) lesions.
The study’s other limitation is the research sample, i.e., the study focused on a ho-
mogeneous group of young women. Moreover, the sample size in this study was not
large. In the future, a larger sample size should participate in the study, including both
women and men with acne in a broader range of age and people without any skin prob-
lems or disease (for comparison). Further, it would be valuable to compare the effec-
tiveness of the hydrogen purification treatment using alkaline water with other cosmetic
treatments using cosmetic acidic pH substances and other topical cosmetics treatments.
5. Conclusions
Hydrogen purification is an effective and safe treatment for acne vulgaris. In this
work, researchers conducted a study on people struggling with acne vulgaris and
showed that hydrogen purification could help treat this disease for the first time. Treat-
ment with hydrogen purification is safe and effective in reducing acne skin eruptions and
can improve the skin’s condition and an appearance by decreasing sebum and increasing
the moisture level in young women. In combination with oral drugs and other topical
therapies, hydrogen purification may be considered to optimize acne treatment outcomes
and overcome the problems encountered with some conventional methods. However, it
is essential to note that hydrogen purification cannot replace drug treatments but may be
used as a supportive topical cure for acne vulgaris, combined with other forms of ther-
apy, according to clinicians’ recommendations [57].
Supplementary Materials: The following are available online at
www.mdpi.com/2227-9032/9/2/144/s1.
Author Contributions: conceptualization, K.C.; methodology, K.C.; software, K.C. and R.S.; vali-
dation, K.C., A.M.R., and R.S.; formal analysis, A.M.R.; investigation, K.C.; resources, K.C. and R.S.;
data curation, K.C. and A.M.R.; writing—original draft preparation, K.C., A.M.R., and R.S.; writ-
ing—review and editing, K.C., A.M.R., and R.S.; visualization, A.M.R.; supervision, R.S.; project
administration, K.C. and R.S.; funding acquisition, R.S. All authors have read and agreed to the
published version of the manuscript.
Funding: An article processing charge was financially supported by University of Opole, Poland.
Institutional Review Board Statement: The study was conducted according to the guidelines of
the Declaration of Helsinki and approved by the Human Research Ethics Committee of the Opole
Medical School (KB/54/NOZ/2019).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study.
Data Availability Statement: The data presented in this study are available in the Supplementary
Materials.
Conflicts of Interest: The authors declare no conflict of interest.
References
1. Heng, A.W.S.; Chew, F.T. Systematic review of the epidemiology of acne vulgaris. Sci. Rep. 2020,10, 5754,
doi:10.1038/s41598-020-62715-3.
2. Dréno, B. Treatment of adult female acne: a new challenge. J. Eur. Acad. Dermatol. Venereol. 2015, 29, 14–19.
3. Anaba, E.L.; Oaku, R.I. Adult female acne: A cross-sectional study of diet, family history, body mass index, and premenstrual
flare as risk factors and contributors to severity. Int. J. Women’s Dermatol.2020, doi:10.1016/j.ijwd.2020.11.008.
4. Picardi, A.; Lega, I.; Tarolla, E. Suicide risk in skin disorders. Clin. Dermatol. 2013, 31, 47–56.
5. Jagtiani, A.; Nishal, P.; Jangid, P.; Sethi, S.; Dayal, S.; Kapoor, A. Depression and suicidal ideation in patients with acne, psori-
asis, and alopecia areata. J. Mental Health Hum. Behav. 2017, 22, 50–54.
6. Koo, E.B.; Petersen, T.D.; Kimball, A.B. Meta-analytic comparing efficacy of antibiotics versus oral contraceptives in acne
vulgaris. J. Am. Acad. Dermatol. 2014, 71, 450–459.
7. Williams, H.C.; Dellavalle, R.P.; Garner, S. Acne vulgaris. Lancet 2012, 379, 361–372.
Pobrano z https://repo.uni.opole.pl / Downloaded from Repository of Opole University 2021-10-19Healthcare 2021, 9, 144 14 of 15
8. Chilicka, K.; Rogowska, A.M.; Szyguła, R.; Adamczyk, E. Association between Satisfaction with Life and Personality Types A
and D in Young Women with Acne Vulgaris. Int. J. Environ. Res. Public Heal.2020, 17, 8524, doi:10.3390/ijerph17228524.
9. Chilicka, K., Rogowska, A.M., Szyguła, R., Taradaj, J. Examining Quality of Life After Treatment with Azelaic and Pyruvic
Acid Peels in Women with Acne Vulgaris. Clin. Cosmet. Investig. Dermatol. 2020, 13, 469–477. doi:10.2147/ccid.s262691.
10. Mazzarello, V.; Donadu, M.G.; Ferrari, M.; Piga, G.; Usai, D.; Zanetti, S.; Sotgiu, M.A. Treatment of acne with a combination of
propolis, tea tree oil, and Aloe vera compared to erythromycin cream: two double-blind investigations. Clin. Pharmacol. Adv.
Appl.2018, 10, 175–181.
11. Contassot, E.; French, L.E. New insights into acne pathogenesis: Propionibacterium Acnes activates the inflammasome. J.
Invest. Dermatol. 2014, 134, 310–313.
12. Makrantonaki, E.; Ganceviciene, R.; Zouboulis, C. An update on the role of the sebaceous gland in the pathogenesis of acne.
Dermatoendocrinology.2011, 3, 41–49.
13. Dabade, T.S.; Feneran, A.N.; Kaufman, W.S.; Feldman, S.R. Retinoid plus antimicrobial combination treatments for acne. Clin.
Cosmet. Investig. Dermatol.2011, 4, 79–92.
14. Oge, L.K.; Broussard, A.; Marshall, M.D. Acne vulgaris: Diagnosis and Treatment. Am. Fam. Physician2019, 100, 475–484.
15. Ohsawa, I.; Ishikawa, M.; Takahashi, K.; Watanabe, M.; Nishimaki, K.; Yamagata, K.; Katsura, K.-I.; Katayama, Y.; Asoh, S.;
Ohta, S. Hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. Nat. Med.2007, 13,
688–694.
16. Qian, L.; Wu, Z.; Cen, J.; Pasca, S.; Tomuleasa, C. Medical Application of Hydrogen in Hematological Diseases. Oxidative Med.
Cell. Longev.2019, 2019, 1–6.
17. Qian, L.; Shen, J. Hydrogen therapy may be an effective and specific novel treatment for Acute Graft-versus-host disease
(GVHD) .J. Cell. Mol. Med. 2013, 17, 1059–1063.
18. Chuai, Y.; Qian, L.; Sun, X.; Cai, J. Molecular hydrogen and radiation protection. Free. Radic. Res.2012, 46, 1061–1067.
19. Buchholz, B.M.; Kaczorowski, D.J.; Sugimoto, R.; Yang, R.; Wang, Y.; Billiar, T.R.; McCurry, K.R.; Bauer, A.J.; Nakao, A. Hy-
drogen Inhalation Ameliorates Oxidative Stress in Transplantation Induced Intestinal Graft Injury. Arab. Archaeol. Epigr.2008, 8,
2015–2024.
20. Żabska, O. Hydrogen purification. Kosmetol Estet. 2018, 7, 417–419.
21. Zeng, K.; Zhang, D.K. Recent progress in alkaline water electrolysis for hydrogen production and applications. Prog. Energ.
Combust. Sci. 2010,36, 307–326.
22. Harris, D.C. Quantitative Chemical Analysis,9thed.; Macmillan: New York, NY, USA, 2010.
23. Shirahata, S.; Hamasaki, T.; Teruya, K. Advanced research on the health benefit of reduced water. Trends Food Sci. Tech. 2012,
23, 124–131.
24. Hong, Y.; Chen, S.; Zhang, J.M. Hydrogen as a selective antioxidant: a review of clinical and experimental studies. J. Int. Med.
Res. 2010, 38, 1893–1903.
25. Chilicka, K.; Maj, J.; Panaszek, B. General quality of life of patients with acne vulgaris before and after performing selected
cosmetological treatments. Patient Prefer. Adherence2017, 11, 1357–1361.
26. Bettoli, V.; Borghi, A.; De Padova, M.P.; Tosti, A. Acne. In Color Atlas of Chemical Peels; Tosti, A., Grimes, P.E., De Padova, M.P.,
Eds.; Springer: Berlin, Heidelberg, Germany, 2006; pp. 113–132, ISBN 978-3-642-05959-9, doi:10.1007/3-540-30223-9_11.
27. Cong, T.X.; Hao, D.; Wen, X.; Li, X.H.; He, G.; Jiang, X. From pathogenesis of acne vulgaris to anti-acne agents. Arch. Dermatol.
Res. 2019, 311, 337–349, doi:10.1007/s00403-019-01908-x.
28. Youn, S.W. The role of facial sebum secretion in acne pathogenesis: facts and controversies. Clin. Dermatol. 2010, 28, 8–11,
doi:10.1016/j.clindermatol.2009.03.011.
29. Ghosh, V.K.;Nagore, D.H.;Kadbhane, K.P.; Patil, M.J. Different approaches of alternative medicines in acne vulgaris treat-
ment. Orient. Pharm.Exp. Med. 2011, 11, 1–9.
30. Chalmers, P.N.; Beck, L.; Stertz, I.; Tashjian, Robert Z. Hydrogen peroxide skin preparation reduces Cutibacterium acnes in
shoulder arthroplasty: a prospective, blinded, controlled trial. J. Shoulder Elbow Surg. 2019, 28, 1554–1561.
31. Singh, A.M.; Sethi, P.M.; Romeo, A.A.; Anakwenze, O.A.; Abboud, J.A.; Namdari, S. Strategies to decolonize the shoulder of
Cutibacterium acnes: a review of the literature. J. Shoulder Elbow Surg. 2020, 29, 660–666, doi:10.1016/j.jse.2019.11.037.
32. Stull, J.D.; Nicholson, T.A.; Davis, D.E.; Namdari, S. Addition of 3% hydrogen peroxide to standard skin preparation reduces
Cutibacterium acnes-positive culture rate in shoulder surgery: a prospective randomized controlled trial. J. Shoulder Elbow
Surg. 2020, 29, 212–216, doi:10.1016/j.jse.2019.09.038.
33. Draelos, Z.D. Cosmetics and Cleansers in Acne. In Pathogenesis and Treatment of Acne and Rosacea; Zouboulis, C.C., Katsambas,
A.D., Kligman, A.M., Eds.; Springer: Berlin, Heidelberg, Germany, 2014; pp. 503–510, ISBN 978-3-540-69374-1,
doi:10.1007/978-3-540-69375-8_68.
34. Schmid-Wendtner, M.H., Korting, H.C. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol.
Physiol. 2006, 19, 296–302, doi:10.1159/000094670.
35. Giampaoli, S.; Valeriani, F.; Gianfranceschi, G.; Vitali, M.; Delfini, M.; Festa, M.R.; Bottari, E.; Spica, V.R. Hydrogen sulfide in
thermal spring waters and its action on bacteria of human origin. Microchem. J.2013,108, 210–214.
36. Goodman, G. Cleansing and moisturizing in acne patients. Am. J. Clin. Dermatol.2009, 10, 1–6.
37. Draelos, Z.D. The science behind skin care: Cleansers. J. Cosmet. Dermatol. 2018, 17, 8–14.
Pobrano z https://repo.uni.opole.pl / Downloaded from Repository of Opole University 2021-10-19Healthcare 2021, 9, 144 15 of 15
38. Kim, M.K.; Choi, S.Y.; Byun, H.J.; Huh, C.H.; Park, K.C.; Patel, R.A.; Shinn, A.H.; Youn, S.W. Comparison of sebum secretion,
skin type, pH in humans with and without acne. Arch. Dermatol. Res. 2006, 298, 113–119.
39. Proksch, E. pH in nature, humans and skin. J. Dermatol.2018, 45, 1044–1052.
40. Schürer, N. pH and Acne. Curr. Probl. Dermatol. 2018, 54,115–122.
41. Gadek, Z.; Hamasaki, T.; Shirahata, S. Nordenauphenomenone application of natural reduced water to therapy. Follow-up
study upon 411 diabetes patients. Anim. Cell Tech. 2009,15, 265–271.
42. Gadek, Z.; Li, Y.; Shirahata, S. Influence of natural reduced water on relevant tests parameters and reactive oxygen species
concentration in blood of 320 diabetes patients in the prospective observation procedure. Anim. Cell Tech. 2006, 14, 377–385.
43. Osada, K.; Li, Y.P.; Hamasaki, T.; Abe, M.; Nakamichi, N.; Teruya, K.; Ishii, Y.; Wang, Y.; Katakura, Y.; Shirahata, S. An-
ti-Diabetes effects of HitaTenryosui water, a natural reduced water. Anim. Cell Technol. 2010, 15, 307–313.
44. Higashikawa, F.; Kuriya, T.; Noda, M. et. al. Verification of improving action of mineral water on lipid metabolism in clinical
trials. In Proceedings of the 7th meeting of the Japanese Society of Preventive Medicine, Kyoto, Japan, 20–21 July 2007; pp. 20.
45. Hamasaki, T.; Kishiwagi, T.; Imada, T.; Nakamichi, N.; Aramaki, S.; Toh, K.; Morisawa, S.; Shimakoshi, H.; Hisaeda, Y.; Shi-
rahata, S. Kinetic analysis of superoxide anion radicalscavening and hydroxyl radical- scaveninging activities of platinum
nanoparticles. Lingmuir. 2008, 24, 7354–7364.
46. Tsai, C.; Hsu, Y.; Chen, W.; Chang, W.; Yen, C.; Ho, Y.; Lu, F.Hepatoprotective effect of electrolyzed reduced water against
carbon tetrachloride-induced liver damage in mice. Food Chem. Toxicol. 2009, 47, 2031–2036.
47. Tsai, C.; Hsu, Y.; Chen, W.; Ho, Y.-C.; Ho, Y.-C. Induction of mitochondrial damage and apoptosis in human leukemia HL-60
cells due to electrolyzed-reduced water and glutatione. Biosci. Biotech. Biochem. 2009, 73, 280–287.
48. Ye, J.; Li, Y.; Hamasaki, T.; Nakamichi, N.; Komatsu, T.; Kashiwagi, T.; Teruya, K.; Nishikawa, R.; Kawahara, T.; Osada, K.; et
al. Inhibitory effect of electrolyzed reduced water on tumor angiogenesis. Biol. Pharm. Bull. 2008, 31, 19–26.
49. Zeng, R.; Liu, Y.; Zhao, W.; Yang, Y.; Wu, Q.; Li, M.; Lin, T. A split-face comparison of a fractional microneedle radiofrequency
device and fractional radiofrequency therapy for moderate-to-severe acne vulgaris. J. Cosmet. Dermatol.2020, 19, 2566–2571.
50. Chilicka, K.; Rogowska, A.M.; Szyguła, R.; Dzieńdziora-Urbińska, I.; Taradaj, J. A comparison of the effectiveness of azelaic
and pyruvic acid peels in the treatment of female adult acne: A randomized controlled trial. Sci. Rep.2020, 10, 12612,
doi:10.1038/s41598-020-69530-w.
51. Youn, S.W. Cosmetic facial skin type. In Agache's Measuring the Skin; Humbert, P., Fanian, F., Maibach, H., Agache, P., Eds.;
Springer: Cham, Germany, 2017; pp. 1379–1383, ISBN 978-3-319-32383-1, doi:10.1007/978-3-319-32383-1_90.
52. Akhavan, A.; Bershad, S. Topical acne drugs: review of clinical properties, systemic exposure, and safety. Am. J. Clin. Derma-
tol.2003, 4, 473–492.
53. Tan, A.U.; Schlosser, B.J.; Paller A.S. A review of diagnosis and treatment of acne in adult female patients. Int. J. Womens Der-
matol.2017,4,56–71.
54. Greydanus, D.E.; Azmeh, R.; Cabral, M.D.; Dickson, C.A.; Patel, D.R. Acne in the first three decades of life: An update of a
disorder with profound implications for all decades of life. Dis. Mon. 2020, 8, 101103, doi:10.1016/j.disamonth.2020.101103.
55. Xu, H.; Li, H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am. J. Clin. Dermatol. 2019,20,335–344.
56. Adler, B.L.; Kornmehl, H.; Armstrong, A.W. Antibiotic Resistance in Acne Treatment. JAMA Dermatol.2017,153, 810–811.
57. Oon, H.H.; Wong, A.N.; Aw, C.W.; Cheong, W.K.; Cheong, W.K.; Tan, H.H. Acne management guidelines by the Dermato-
logical Society of Singapore. J. Clin. Aesthet. Dermatol. 2019, 12, 34–50.
Pobrano z https://repo.uni.opole.pl / Downloaded from Repository of Opole University 2021-10-19You can also read
